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NPI Code Detail

MEDICARE: THEODORE EVAN DUSHANE PH.D., M.D.

MEDICARE: THEODORE EVAN DUSHANE PH.D., M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician259689NY

General Provider Information

NPI Number : 1265534515
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE EVAN DUSHANE PH.D., M.D.
Provider Business Mailing Address
First Line : 3998 FAIR RIDGE DR
Second Line : SUITE 300
City : FAIRFAX
State : VA
Zip : 22033-2921
Country : US
Telephone Number : 703-295-9360
Fax Number : 703-766-9725
Provider Business Practice Location Address
First Line : 100 WOODS RD
Second Line :
City : VALHALLA
State : NY
Zip : 10595-1530
Country : US
Telephone Number : 914-493-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 04/01/2015

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